Inaugural-Dissertation zur Erlangung der medizinischen Doktorwürde an den Medizinischen Fachbereichen der Freien Universität Berlin

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1 Aus der Klinik für Anaesthesiologie und operative Intensivmedizin des Klinikums Benjamin Franklin der Freien Universität Berlin Leiter: Univ.-Prof. Dr. med. Christoph Stein Die Bestimmung des Sauerstoffverbrauchs bei Patienten mit Sepsis. Ein Methodenvergleich zwischen der Berechnung mit der Fickschen Formel und der indirekten Kalorimetrie. Inaugural-Dissertation zur Erlangung der medizinischen Doktorwürde an den Medizinischen Fachbereichen der Freien Universität Berlin vorgelegt von Dagmar Bischoff aus Minden

2 Referent: Herr Professor Dr. med. Walter Schaffartzik Korrefenrent: Herr Professor Dr. med. Christoph Stein Gedruckt mit Genehmigung des Fachbereichs Humanmedizin der Freien Universität Berlin Promoviert am

3 1 Inhaltsverzeichnis Seite 1. Einführung Physiologische Grundlagen des Sauerstofftransportes Der Sauerstofftransport bei kritisch kranken Patienten Meßmethoden des Sauerstofftransportes Kalkulation von VO 2 und DO 2 mit Hilfe der Fickschen Formel Kalorimetrie Direkte Kalorimetrie Indirekte Kalorimetrie Meßprinzip Geschlossene Systeme Offene Systeme Methodische Probleme Metabolic Monitor Anwendungsgebiete 9 2. Ziel der Untersuchung Material und Methodik Patienten Methodik Kalkulation mit der Fickschen Formel Indirekte Kalorimetrie Berechnungen Untersuchungsprotokoll Statistische Auswertung 20

4 2 Seite 4. Ergebnisse Diskussion Ergebnisse der vorliegenden Studie Vergleich mit anderen Studien Effekte von Dobutamin Statistische Probleme Probleme der Meßmethoden des Sauerstofftransportes Fehlerquellen der indirekten Kalorimetrie Fehlerquellen der Kalkulation mit Hilfe der Fickschen Formel Pulmonaler Sauerstoffverbrauch Erhöhter pulmonaler Sauerstoffverbrauch bei Pneumonie Koronarer Blutfluß über die Venae Thebesiae Vergleich zwischen der Kalkulation mit Hilfe der Fickschen Formel und der Spirometrie Zunahme der Methodendifferenz und zunehmende Streuung der Differenzen bei hohem VO Klinischer Nutzen der indirekten Kalorimetrie beim kritisch kranken Patienten Zusammenfassung Literatur Danksagung Lebenslauf 56

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18 55 8. Danksagung Mein erster Dank gilt Herrn Professor Dr. med. Walter Schaffartzik für die Überlassung des Dissertationsthemas und für die kritische Diskussion bei der Fertigstellung meiner Arbeit. Herrn Oberarzt Dr. med. Carsten Sanft danke ich für die organisatorische und klinische Betreuung der Studie sowie seiner Unterstützung bei der Anfertigung des Manuskripts. Dem Team der Abteilung für medizinische Statistik des Klinikums Benjamin Franklin der Freien Universität Berlin danke ich für die Hilfe bei der statistischen Auswertung der Daten. Ich möchte mich auch bei den Patienten beziehungsweise ihren Angehörigen bedanken, die die Einwilligung zu dieser Studie gaben. Nicht zuletzt danke ich meinem Bruder stud. ing. Andreas Bepperling für die gute Zusammenarbeit.

19 56 9. Lebenslauf Angaben zur Person Name: Vorname: Geburtstag und ort: Wohnort: Bischoff Dagmar in Minden Werther Str. 118, Bielefeld Schulbildung und Studiengang Grundschule Windheim-Döhren Städtisches Gymnasium Petershagen Allgemeine Hochschulreife Studium der Medizin an der Freien Universität Berlin Ärztliche Tätigkeit Arzt im Praktikum in der I. Inneren Abteilung des Auguste-Viktoria-Krankenhauses, Berlin Chefarzt Prof. Dr. med Meyer Weiterbildungsassistenz in einer internistisch-kardiologischen Praxisgemeinschaft Weiterbildungassistenz in der Kardiologischen Abteilung des Herz- und Diabeteszentrums Nordrhein-Westfalen Chefarzt Prof. Dr. med Horstkotte Seit Weiterbildungsassistenz in der I. Medizinischen Klinik des Franziskus-Hospitals, Bielefeld Chefarzt Priv.-Doz. Dr. med Steffen